Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients [post]

M. Victoria Pendon-Ruiz de Mier, Raquel Ojeda, M. Antonia Álvarez-Lara, Ana Navas, Corona Alonso, Javier Caballero-Villarraso, Pedro Aljama, Miguel A. Álvarez, Sagrario Soriano, Mariano Rodríguez, Alejandro Martín-Malo
2020 unpublished
Background Acute kidney injury (AKI) occurs in 12-20% of multiple myeloma (MM) patients. Several studies have shown a reduction of free light chains (FLC) using hemodialysis with High-Cut-Off membranes. However, this technique entails albumin loss. Hemodiafiltration with ultrafiltrate regeneration is a technique that includes a process of adsorption. The aim of this study was to evaluate the effectiveness of hemodiafiltration with ultrafiltrate regeneration in reducing FLC levels without
more » ... vels without causing albumin loss. Methods This is an observational study (2012 to 2018) including eleven patients with MM (6 kappa, 5 lambda) and AKI. All patients were treated with chemotherapy and hemodiafiltration with ultrafiltrate regeneration. Blood Samples (pre and post-dialysis) and ultrafiltrate were collected pre and post-resin at 5 minutes after initiation of the session and 5 minutes before the end of the procedure. Results The serum levels of kappa and lambda were reduced by a 53±14% and 33±22% respectively. Serum albumin concentration remained unchanged after the procedure. In the ultrafiltrate, the mean FLC reduction ratio shortly after initiation of the dialysis procedure was: 99.2% and 97.06% for kappa and lambda respectively, and only 0.7% for albumin; and at the end of the session the percent reduction was: 63.7% and 33.62% for kappa and lambda respectively, and 0.015% for albumin. Patients clinical outcome was: 36.4% recovered renal function, 18.2% died during the first year and 45.45% required maintenance dialysis. Conclusions Hemodiafiltration with ultrafiltrate regeneration reduces FLC levels without producing a significant loss of albumin; and, FLC removal is maintained throughout the session. Therefore, hemodiafiltration with ultrafiltrate regeneration may be considered an effective adjunctive therapy in patients with MM.
doi:10.21203/rs.2.22309/v2 fatcat:zgxpudttsbhgtolk5mao4xw6hm